Provider Demographics
NPI:1851582092
Name:DIXON, DONOVAN D (MD,)
Entity Type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:D
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 RAMSEY STREET
Mailing Address - Street 2:SUITE 109-237
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7675
Mailing Address - Country:US
Mailing Address - Phone:347-452-9437
Mailing Address - Fax:910-488-7770
Practice Address - Street 1:812 CANDY PARK ROAD 5101
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7322
Practice Address - Country:US
Practice Address - Phone:910-522-1143
Practice Address - Fax:910-522-1162
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237457207Q00000X
NC201001347207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916910Medicaid
2077184Medicare UPIN